Plus ca change … American medical journals seem to have been as hospitable to verbose pro-circumcision tirades in 1902 as they have become since the 1990s. Here the prominent anti-foreskin activist, Peter Charles Remondino, attacks the enemies of circumcision as prejudiced, backward and unscientific.

Circumcision and its opponents

The preventive practice of medicine mentioned so very long ago by Xenophon as being something of the greatest importance, will only become a recognized necessity and practice when mankind, however seemingly enlightened or civilized, will cease to look upon diseases and their cure from the narrow and benighted point of view of the Congo Negro, and when the race will emancipate itself from that degree of irrationality that, figuratively speaking, permits men to swallow a camel without winking, whilst they go through fearful contortions of strainings when attempting to swallow a gnat.

This rather uncomfortable and pessimistic view of persistent human irrationality in this particular line of our sociologic existence was forcibly impressed upon me by the perusal of an article in one of our medical journals which professed to see no benefit whatever in circumcision – neither from an hygienic, preventive, pathologic or humanitarian pint of view – whilst attending the deathbed of a middle aged man who, had he been fortunate enough either to have been born a Jew or a Turk, or to have fallen into the hands of an energetic and persistent advocate of circumcision when a child, would not only have been spared some long eight months of atrocious suffering, but would then in all probability have lived to a very comfortable age.

[Details to make your flesh crawl]

The patient was, at the time of the appearance of his misfortune, a compactly built man of some 49 years of age, robust and of an active disposition. His compact and muscular as well as active physique was what might have been looked for in a well-trained and athletic Roman legionary in the days of Rome’s glory. He was possessed of more than usual intelligence, was quick witted, and was otherwise in a state of prime health, far above that of the average man at his age. Possessed of a good appetite, and of as good digestion as assimilation, he was of an optimistic and cheerful frame of mind, carrying his two score and ten years as if not more than thirty; with elastic step, strong physique in perfect physiologic action, this man entered and went through an agonizing existence of eight months duration, through the occurrence of preputial and penile cancer, ending in death, and all because he had not been circumcised, or, as has been said, had missed being born a Jew, a Turk or a Mohammedan.

As an intelligent but irascible Scotch gentleman who had been raised in strict Scottish Presbyterian lines in his native land, and who had been brought up on oatmeal gruel, the scriptures and in a wholesome fear of the Lord, once expressed himself to me, after having been circumcised and convinced that much of his neurasthenia and resulting ill-health were all reflex conditions due to a tight prepuce:

I have been brought up and educated to look upon Saint Paul, the founder of Christianity, with awe and admiration, but, by God, Sir, if I had Saint Paul here now, Sir, I would shoot him, yes, Sir, I would shoot him. He had no biblical warrant nor no business to summarily abolish circumcision as he did. Our Lord was circumcised, so were the twelve apostles, even to that rascally Judas, and we should have all been circumcised instead of being baptized. I see that very plainly now. Saint Paul was more of an evangelist and not as scientific a man as Moses, and I may be wrong in wanting to shoot him. He probably did not know the harm he was entailing on gentile humanity by abolishing circumcision. Still, when I think of the agonies I have been made to suffer through his carelessness, I feel he ought to be shot, sir.

Saint Paul undoubtedly did humanity, especially Christian humanity, great wrong in every way when he failed to retain circumcision as a religious rite.

“Spilsbury et al [ 1 ] cite Wallerstein, an anti-circumcision propagandist, failing to point out that many Victorian ideas favouring circumcision have since been confirmed (penile cancer, balanoposthitis, syphilis, etc.).”

I may say without any exaggeration that I have circumcised thousands, and that I have been consulted over more cases of unfavourable results from circumcision and complications arising in the course of the after-treatment than generally falls to the lot of the ordinary physician. I have seen both physical and mental suffering resulting from marplot operators and as a result of ignorance and inexperience as to the conduct of the dressings, but all of the resulting suffering due to properly and improperly performed operations, or to a too meddlesome idea of after-treatment and to very improper dressings, that I have so far witnessed as attending or following circumcision, could they all be rolled into one spasm of physical pain or concentrated into one pang of mental anguish, they could not be compared to the pain, anguish, and sufferings of body and mind of the uncircumcised victim of that preputial or penile cancer that slowly eats its way up from the affected prepuce or glans into the inguinal glands and thence into the abdominal walls and cavity.

[Uses must be found for new medical technology]

With the advantages offered by the employment of local anaesthesia and aseptic dressings, the patient, whether infant, adolescent or adult, need no longer suffer pain during the operation, nor run the seemingly needless risks that at times beset general anaesthesia. With modern methods and means of dressing the operative wound, the patient, if an adult, need no longer remain from his usual vocation, and if a child is no longer subject to the annoyances, dreads and torturing pains caused by the removal of hardened and adherent dressings, nor the interference to the healing by first intention by the repeated bathings that were formerly employed and very necessary to remove the soiled and agglutinated dressings. The stitch suppurative process and the painful ordeal of removing the sutures have been done away with by the discarding of the old silk suture material, a procedure that was wont to alarm and worry the little fellows into spasms. In place of the suppuration and infection-inducing silk, we now employ the absorbable chromacised catgut, which lasts sufficiently long for required purposes, causes no harm, and then disappears. In aristol we have an aseptic, adhesive and protective dry dressing that for young children is unequalled. The wound heals as kindly and thoroughly under aristol as it would under a dressing of asepticised collodion, with none of the drawbacks of the latter.

[Circumcision is vaccination]

Under these circumstances, which minimises the annoyances, pains and time of healing to the plane of an ordinary vaccination, I cannot well see why the operation of circumcision should be classed barbarous any more than vaccination. No intelligent parent who has seen the easily procurable statistics concerning the ratio in smallpox cases of unvaccinated to the vaccinated, the latter forming but the small average of less than 6 per cent of those attacked by smallpox, would permit his children to go unvaccinated. Smallpox, however, is a disease that falls under public care, and these statistical figures are easily and properly obtainable and classified, while cases of cancer, of hernia, and of the thousand and one complications that originate in the uncircumcised, are in private practice, and it is only by long and general experience that one can form even an approximate idea of the risks run by the latter class of cases; but from these an observer can easily conclude that, while the unvaccinated are only exposed to one danger, that the uncircumcised are exposed to many more, while the sufferings undergone by the uncircumcised when attacked by the maladies their condition invite, are altogether in greater excess and out of proportion to those suffered by those who have at some time in their lives undergone the operation of circumcision.

[More or less, sooner or later]

The history of the case of penile cancer mentioned above is not an uncommon occurrence for those who are the unfortunate possessors of an annoying prepuce. This organ or its tissues often become irritated, or rather the seat of an irritation on its mucous coat, followed with more or less inflammatory infiltration and thickening of the whole preputial tissues to an extent that it interferes with its retraction. Bathings, soothing lotions and rest generally cause this to subside, when some mild applications and lint, or some dry gauze interposed between the opposing mucous surfaces soon restore the parts to their usual state of health.

At times, however, something which in these cases is liable to occur sooner or later, an unusually severe or persistent attack, and a more than usual thickening and induration of the affected tissues, causes the prepuce to press upon the glans with more than its former or usual degrees of constriction, and we have, as a result, more or less necrosis of tissue and a more or less resulting extensive suppurative and reinfecting inflammation. The sufferer often neglects to apply to a physician, considering the affair the customary trivial attack that will pass away in a day or two; but the recovery is now unaccountably postponed from day to day, and when at last he begins to think of consulting a physician, the latter finds that the prepuce has undergone some pathologic changes, and that a regular circumcision is for the time being out of the question. He slits up the hardened, thickened and lardaceous prepuce on its dorsum to liberate the compressed glans, which is then often found ulcerated and suppurating on its surfaces, and then trims off the remaining dog-ears which stand up erect on either side of the cut and whose edges refuse to hold sutures; and after a longer or shorter period of unsatisfactory local treatment the patient recovers with possibly a normal glans, and just possibly with one more or less disfigured as if it had gone through the pitting process of smallpox, and possibly with some segment of the corona permanently missing as a result of extensive suppurative destruction. …

[There follows a lengthy and increasingly lurid account of the progress of one case of penile cancer that Remondino claims to have observed.]

Considering the many reflex disorders that do arise from the presence or existence of the prepuce, and the great diversity and far-reaching consequences of these disturbances, I cannot well see how one can rationally cry down circumcision as not being a most useful and salutary preventive measure. Hydrocele, hernia, hip joint disease, epilepsy, asthma, disturbances of speech or of sight, and a whole category of diseases can often be trace to their origins in some preputial irritation or cause. Some of these cases are most peculiar as well as instructive.

[Circumcision prevents or cures blindness]

Some years ago I was called to see a young man who was said to be going blind. I had known him for several years and could hardly account for such a calamity overtaking him. On examination I could perceive no change in the eyes, and, as he expressed it, he felt no pain, only that his sight had gradually dimmed and failed until now he could hardly distinguish light from darkness. Satisfied after a careful examination that there existed no organic defect in the eyes, and after eliminating all other possible causes, determined to examine the prepuce, as I had seen a number of cases of eye trouble resulting from preputial irritability. When asked to expose the parts the patient remarked that he knew what I referred to, but that as he had been circumcised, that the prepuce could not be looked to as the cause of his calamity.

“The Victorians cited many of the same medical conditions associated with uncircumcised penises as do people today.”

Thinking perhaps that there might accidentally be some cicatricial constriction or malformation resulting from the operation that might cause the difficulty, I nevertheless insisted on examining the parts, especially as I had exhausted every other possible source of origin or cause for the eye trouble. Very reluctantly the young man disrobed, and to my surprise drew forth what looked like a yellow doll done up in thin and shiny garments. It was his circumcised organ done up in a wrapper of oiled silk with a tight rubber band about the fossa back of the corona to hold it in place. Without any hesitation I pronounced the constriction from the rubber band to be the cause of his eye trouble, and removing the oiled silk ulster and the rubber band, the patient regained his full scope of vision within the next hour.

Upon being questioned as to the cause of his wearing that yellow jacket like a Chinese mandarin of high degree, he informed me that after his circumcision, some years previously, he had always carried the décolleté member in a bag or sheath made of muslin, being under the impression that it needed protection. About one week previous to my being called, a friend had advised his wearing the yellow oil silk shirt with a rubber band to hold it in place. The band was smaller in diameter and stronger in texture than was actually necessary, and although he had noticed the constriction as being a little painful, and he now recalled that his eye difficulties had appeared soon after donning the yellow jacket, he had failed to make any connection between the unusual constriction and the failing sight.

In a lad of twelve who came under my care for blurred vision, whose inability to read was supposed by his parents to be due to the presence of worms, as worms had previously caused other reflex difficulties, was found upon examination, and as proved by the results of the operation undertaken for his relief, to owe his eye difficulty to a tight prepuce and to the existence of some preputial adhesion.

[Hip and bone diseases]

With the effectual removal of the prepuce we certainly remove all possibilities for the occurrence of any cancerous disease having for its seat the preputial tissues or, for its cause, its irritating or constricting presence. Its removal will also do away with the possibility of being affected with one of those excruciatingly painful attacks of sciatica, which at times will lay up its victims for weeks or eventually cripple him with what Mauriac terms neuralgic herpes of the genito-urinary organs, who described these forms of sciatica as originating in an inflammatory vesicular eruption that is usually located on the inner lining or mucous coat of the prepuce, the nervous peripherae of this membrane giving rise through their irritation to this and to many other troubles that come from the same cause.

Wherever any of these herpetic derangements of the preputial mucous membrane are met with as the easily excited results of heedless indiscretion either at the shrine of Venus or Bacchus, or a too indiscriminate indulgence in highly seasoned viands, we may feel assured of having in such cases an easy culture field for the occurrence of cancer whenever age and other favouring conditions meet in combination. Such a person will court safety by the constant practice of the virtues of continence, sobriety and studied abstemiousness. To make this doubly sure, however, I should advise him, especially if possessing what the late lamented Prof. S.D. Gross was wont to term a redundancy of preputial tissue, to follow the example of Timothy, the friend and companion of St Paul, and go and have himself circumcised, and thusly avoid the prospect of a painful and a questionable or disreputable death after a most uncomfortable malady, as the laity most always attach some venereal cause as the factor in such a death.

“If I were a top,* and I didn’t like to use condoms, I would consider getting circumcised. If that person is not going to use a condom, maybe we’d all be better off if that person was circumcised.”

* That is, a gay male taking the active or insertive role in anal intercourse. Does Mr Halperin imply that he is not a top, that he does use condoms and that he is not circumcised?

It is these cases, combining herpetic attacks with nervous or neuralgic disorders, that form much of the groundwork or foundation for those annoying cases of coxalgia [pain in hip joint] that insidiously creep on, undermining the health and ending in crippling deformities after a protracted spell of femoral or of acetabular arthritis [in hip socket], with the resulting destructive process of osseous absorption and necrosis, the course of the initial points of the disorder being in every way analogous to those in which we observe the occurrence of simple sciatica originating in preputial herpes.

It is very evident that if there is any virtue in the practice of preventive medicine that our duty here is to circumcise, and to do this promptly. While late operations and times and most unexpectedly give astonishingly happy results, we must not overlook the fact that we cannot logically look for results from preventive methods when conditions have progressed and passed to points where only other and curative methods are applicable. We should here be guided by the rule adopted and taught by Jonathan Hutchinson, that the most proper and considerate time to operate upon a cancer is in its pre-cancerous stages, and we should treat all easily irritated prepuces in the light of pre-cancerous or pre-coxalgic conditions. [ 2 ]

Opponents of circumcision, when claiming that the operation has no well-defined hygienic or preventive benefits, seem to me to be arbitrarily ignoring many well known and established propositions in medicine and surgery. To argue thus in the face of the teachings of Lewis A. Sayre, Jonathan Hutchinson and many other careful, accurate and conscientious observers, and in the face of daily occurring evidences where a timely performed circumcision relives many cases so effectually and so promptly as to leave no reasonable cause for believing but that the offending and removed prepuce was the exciting and maintaining cause of the disturbance, seems to me but additional cause for believing that those who so argue must deliberately shut their eyes as to all evidence, as well as to reason, are more intent on nourishing their prejudices than in exercising their reasoning faculties in an Aristotelian sense.

[Circumcision cures cripples]

I was once called to give an opinion over a case of femoral necrosis with suppuration following coxalgia in a young boy. The child, when beginning to favour the affected leg, had fallen into the hands of what might purely be termed a sample of the quintessence of the ignorant and irregular order of female practitioners with which the country abounds, a class of women who could not intelligently run a poultry yard, but who find in church associations and in the protected shades of medical sectarianism and faddism and social ignorance of medicine sample support and fields for the exercise of their peculiar order or want of talents [SIC]. It is needless to say that the serious gravity of the case here went unrecognised, and that the poor lad went from bad to worse.

[Attack on women doctors]

In time the lad fell under the notice of one of those curb-stone and street corner patient-recruiting doctors who, calling on the father of the child, so impressed him with the profundity and the superiority of his own knowledge over that possessed by the mentally irresponsible specimen of the irregular but solemn-visaged female practitioner, that he managed to assume charge of the case. He had charge of the case for several months when I was called in for an opinion. He had burrowed about the sinuses and necrosed tissues in a most indefinite and unsurgical manner at various times during the course of his attendance, to no good or to no ends, and at the time of my visit, at which he was present, seemed to have no clearly defined ideas as to what he intended to do or should do.

On looking over the child, what was my surprise to find a long, tight and adherent prepuce, which in all probability was the original incentive of the whole disease processes which had eventually crippled the child and reduced it to a pitiable plight. Now, this disciple of Paracelsus Bombastus, or curb-stone and church lobby handshaking proclivities, was by no means an opponent of circumcision, only he was naturally and passively ignorant and unreceptive, and had never studied or understood the subject of coxalgia in all of its bearings and, in reality, was no more or only a little better fitted to assume charge of the case than was the solemn and owlishly wise-looking irregular female from whom he had so ingeniously swiped it.

As observed, the failure to recognise the probable cause in this case was, in the hands of either of these two practitioners, pure ignorance, naturally leading to what, in better informed hands, would be criminal carelessness and inattention, but in many like cases men of small calibered minds are apt to be too easily influenced by the oft-repeated denials made by the opponents of circumcision as a general practice, that cancer, hypertrophies, excrescences, sciatica, coxalgia, reflex diseases and other derangements that at times accompany the existence of a prepuce, are either the direct or reflex outcome of the possible result of natural evolutionary growing out of the irritating presence of a prepuce. Under such misguidance they neglect to recognize the true state of affairs or to perform the operation early enough to act preventively; and at times when they do perform it later on, and at a time when the derangement for whose relief it is intended has become a settled disease, the operation is followed by no appreciable result, it only confirms them in the righteousness or correctness of their views and practice, that the prepuce was not an inciting cause, and that circumcision has no preventive value.

Many of these reflex disturbances remain for a longer or shorter period easily removed, mere functional derangements, before becoming the actual seated disease which they or a time simply simulate; and the period when the actual change takes place from a simulated to a settled disease is as indefinite as the point or period when a benign wart or tumour reaches the precancerous stage, and from this swiftly passes into the cancerous. I have at times operated upon cases where great reflex disturbances had long existed, and where the operation was performed with no hope of their relief, but simply because the local preputial conditions demanded interference, when to my surprise the reflex difficulty has gradually disappeared.

[Another miracle cure]

Some 25 years ago, whilst in charge of a country hospital, I circumcised an inmate, a man of thirty, who was a cripple, seemingly, as the history told me, from the results of a coxalgia when a child. The right leg was neuralgic and apparently shortened, and drawn up in the peculiarly flexed and fixed position characteristic of such cases. It had been so for many years, was gradually going for the worse, and the helpless cripple had drifted into hospital. It was not, however, for the relief of this that he applied to me, but for the relief of a bladder affection which necessitated an examination. I found a long, tight, pin-holed, pendulous prepuce which he had never, even as a child, been able to retract. After questioning the man as to his previous physical history I gave it as my opinion that the crippled leg was the direct outcome of the preputial condition. I advised circumcision to relieve the bladder irritability and to make a urethral stricture more accessible for treatment, when, to my surprise, after the operation the neuralgic pain subsided and the deformity of over 25 years standing gradually lessened. Massage and passive motions were then instituted, and he recovered the almost perfect use of his leg, left the hospital and went to work.

In this case some unseen and unusual constitutional resistance worked to prevent irreparable injury through the occurrence of arthritic inflammation. The least accident or taint of scrofula would here undoubtedly have turned the tables against him. Possibly the degree and nature of the persistent reflex muscular contraction were insufficient to induce serious injury to the head of the femur, but in any case the history of this case teaches us the benefits that may at times be derived from circumcision in the most seemingly hopeless cases. As observed, the results were here most unexpected, and I should be hardly be sanguine enough to see them repeated; but still, what has occurred in one case may in another, and the smallness of the percentages of these happy results should not prevent us from extending the benefits to others affected in analogous manner.

Figure 2 represents a case of preputial hypertrophy somewhat similar to that of the celebrated case recorded many years ago in Paris by M. Nelaton. … The photograph [of a freakish case of gross elephantiasis of the penis] speaks for itself as to the nature and degree of the deformity. The observed enlargement was wholly preputial in its origin and subsequent growth, and never involved the penile organ, and the operation taken for its relief was perfectly successful. To say that circumcision would not have prevented the occurrence of this condition is not a tenable proposition. It is equally certain that the hypertrophy might have entailed more serious concurrent affections than the single one operated on. Had the man been circumcised when a child, all this annoyance and risk would have been averted.

[Anti-circumcision activists]

The opponents of circumcision are by no means all blindly dogmatic and unreasonable in their opposition. Many only class such operations as unnecessary when performed on seemingly perfectly normal subjects. The danger from the opposition resides in those narrow, inelastic and unbending understandings who have made of uncircumcision such a creed, that they have so steeled themselves against its performance, that they will not and cannot under any circumstances ever see or realize the necessity of its performance. Like the Negro preacher and exhorter of “the sun do move” celebrity, they undertake to stick to what to them has become a religious tenet, a scriptural text or truism, no matter what may happen. Not alone are they an injury to themselves and others in their restricted conceptions of medicine and lines of practice, but carrying their prejudiced disbelief in other channels of our science, they at least reach that point where disease and medicine appear to them as purely empirical and unretroactive conditions, and only responsive to the most empirical penny-in-the-slot methods of practice.

“The RACP’s statement on routine male circumcision is not evidence based and should be retracted”.

[Compared with the Remondinian outpourings of Prof. Morris and Co, the RACP’s policy statement (2002-4) is a model of balance, and an obvious compromise between the pro-circumcision hawks, on one hand, and the advocates of genital integrity and a person’s right to make his own health decisions on the other.]

In many respects the opponents of circumcision as a general practice may be likened to the anti-vaccinationists, who magnify the risks and dangers as well as the accidental evil results of vaccination, while they attempt to minimize its immunities and advantages. History and experience do not side with either of these opponents, and it is only by adopting the most one-sided views that one can in the least arrive at anything like a comprehension of their views, or how these are reached by them.

SOURCE: P.C. Remondino, “Circumcision and its opponents”, American Journal of Dermatology and Genito-Urinary Diseases, Vol. 6, March 1902, pp. 65-73